Healthcare Provider Details

I. General information

NPI: 1770646598
Provider Name (Legal Business Name): OXFORD DENTAL SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 10/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2408 S LAMAR BLVD. SUITE 1
OXFORD MS
38655
US

IV. Provider business mailing address

2408 S LAMAR BLVD. SUITE 1
OXFORD MS
38655
US

V. Phone/Fax

Practice location:
  • Phone: 662-513-4188
  • Fax: 662-513-4180
Mailing address:
  • Phone: 662-513-4188
  • Fax: 662-513-4180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number3306-04 PEDO-397-06
License Number StateMS

VIII. Authorized Official

Name: DR. CHARLES H. PERKINS
Title or Position: PARTNER - MANAGING
Credential: DMD
Phone: 662-513-4188